Oleksandr Kravets

Introduction. The incidence and features of acute pancreatitis stimulate the scientific community and clinicians to look for new antibiotics and new algorithms for their use in treating this disease, which is the world's third most frequent acute surgical disease. Despite this, acute pancreatitis mortality indicates the need for better approaches, especially in conditions of microbial resistance to antibiotics, which determines the urgency of the problem. The objective of the paper was to justify lymphotropic antibacterial therapy as an alternative method of treatment of acute pancreatitis based on the changes in specific immunity parameters, which will make it possible to increase the effectiveness of treatment of the disease and potential complications. Materials and methods were based on the study of the leukocyte index of intoxication, the hematological index of intoxication, and some other parameters of immunity on lymphotropic and standard antibacterial therapy. With this in mind, patients were divided into two groups. Results. It was established that under the influence of lymphotropic antibacterial therapy, the leukocyte index of intoxication decreased by 0.3392 units on early admission and by 0.4128 units on late admission compared to standard antibacterial therapy. LAT appeared to be more effective in terms of the effect on HII – by 1.1214 units on early admission and by 1.0537 units on late admission. The effect on cellular immunity with LAT was more pronounced than that with standard antibacterial therapy. Discussion. Purulent-infectious foci in acute pancreatitis lead to profound disturbances in the immune system as they develop intensively and quickly, and already after 24 hours of manifestation, they significantly exceed those that develop within 24 hours. Lymphotropic antibacterial therapy adjusts these changes bringing them closer to the control ones, while standard antibacterial therapy fails to do so. Conclusions. Changes in the immune system parameters, which tend towards the control ones, suggest that lymphotropic antibacterial therapy is an alternative to standard therapy.

Introduction. Treatment of patients with thyroid cancer (TС) with clinically undetected metastases to regional lymph nodes remains an unsolved problem of modern oncology. The search for reliable diagnostic methods, which underlie the decision to perform an adequate lymphadenectomy for TC, is one of the priorities of oncosurgery. The aim of the research: to find an effective method of intraoperative contrasting of sentinel lymph nodes (SLN) in patients with TC using toluidine blue and to evaluate its effectiveness. Methods. A study of 123 patients with TC who underwent surgical treatment using the contrast-visual method in the amount of thyroidectomy with central and bilateral selective cervical lymph node dissection (levels VI; IIA; III; IV). During surgery, a 1% solution of toluidine blue was injected into the tumor using a syringe. Surgical treatment was performed in two stages. At the first stage – thyroidectomy was performed in a block with a central lymphatic collector of the neck (level IV), which included removal of paratracheal, prelaryngeal, parathyroid tissue of the neck. Urgent intraoperative histological examination of thyroid tumor and distant SLN was performed. In the second stage of the operation performed cervical lymph node dissection with removal of fiber IIA; III; IV levels of the neck, with mandatory revision of the level of VB. After the operation, the final histological examination of the removed specimen with the tumor and all lymph nodes was performed. Results. After the application contrasting technique, SLN were found in 120 (97.6%) patients. Their number varied from 2 to 12. These lymph nodes were mainly localized in the central collector of the neck on the side of the primary tumor (central, ipsilateral SLN) in 91 (75.8%) patients. Based on the results of an intraoperative study of SLN, metastases were found in 33 (27.5%) of 120 patients. In most cases (83.3%) SLNs were detected in the central lymphatic collector of the neck (level VI). In 76 (63.3%) patients, staining of the lymph nodes of the III level of the neck (middle ipsilateral jugular lymphatic collector) occurred, in 11 (9.2%) SLNs were found only at levels III, IV and VB of the neck. Very rarely (5.8%), the lymph nodes of the anterior-superior mediastinum were contrasted. Conclusions. The method of contrast visualization of the regional collector in patients with TC using a 1% solution of toluidine blue is a highly informative study that allows to determine the regional lymph nodes affected by metastases and to differentiate the choice of the volume of lymph node dissection in the early stages of tumors. The method is simple to implement, does not involve considerable costs and can be recommended for use in oncology clinics.